When Casey Gannon returned from Iraq two years ago, it wasn’t long before he realized that all was not well. \r

\rThe 2003 Clinton High School graduate spent seven months in Iraqas a Marine reservist assigned to combat patrols, making sure the streets of Fallujah were safe for civilians. He was fortunate to return home without physical injury, but he is not the person he was before he went to war. \r

\rMr. Gannon, 24, who now works as head of grounds maintenance for the Clinton School Department, said he still relives some of the horrific things he saw and experienced in Iraq.

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“I can’t really sleep and I can’t really be in places I’m not familiar with. I’m seeing a psychiatrist at the VA in Jamaica Plain, but it’s not helping,” he said in a recent telephone interview. \r

\r Mr. Gannon is among the tens of thousands of military personnel who return from war with post-traumatic stress disorder. But he sought help rather than suffer in silence. \r

\r According to the Veterans Administration in Boston, one in five veterans returning from the wars in Iraq and Afghanistan is suffering from PTSD. It is the No. 1 mental health diagnosis among returning veterans, followed by depression. Among Vietnam theater veterans, 31 percent of men and 27 percent of women have had PTSD in their lifetime, according to the National Center for PTSD. \r

\r Substance abuse is also a major problem among veterans of the Vietnam, Iraq and Afghanistan wars. And in these tough economic times, homelessness and joblessness are also expected to rise. \r

\r Dr. Mel Tapper, who is with the VA Boston Health Care System, is in charge of screening every returning veteran from Massachusetts. He said the number of PTSD cases is likely higher than currently reported because it can take months to manifest. Veterans are now being reassessed at the 90-day and 180-day return points, he said. \r

\r “No one goes over there and comes back exactly the same, because you have experienced an incredibly unique, difficult experience being in war,” he said.

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Most service members returning from combat zones are able to readjust over time to civilian life. “But some can’t,” Dr. Tapper said, “because the experience has been so difficult for them, and because of their psychic makeup these issues have created these emotional problems that may require treatment.” \r

\r Lyndon C. Jones, team leader at the Worcester Veterans Center, said the Grafton Street facility provides therapy for about 400 to 500 veterans with PTSD. Some are veterans of the current wars, but the vast majority are from the Vietnam era. Individual, group and family therapy is provided as well as a yoga de-stressing program. \r

\r Mr. Jones said anybody who has sustained a traumatic event can have PTSD. “PTSD is something you live with … something that stays there. You don’t ever forget it. But what you do is find a better way of coping so you make your life better,” he said. \r

\r The Worcester Veterans Center, one of six in the state, was started in 1979 to provide services for Vietnam War veterans, Mr. Jones said. \r

\r Screening for PTSD was not readily accessible when William H. Moore of Cherry Valley retired from the Air Force in 1980. He said it took him 15 years before he finally sought help for PTSD he suffered after he nearly died in 1979, when an F-111 jetfighter crashed and exploded near him. \r

\r He was working as a crash rescue firefighter at Cannon Air Force Base in Clovis, N.M.\r

\r Mr. Moore said that when he returned home, he was confrontational, had relationship problems, and small things would send him off the deep end. His wife, Donna, called him Dr. Jekyll and Mr. Hyde. He finally went to the Worcester Veterans Center, accompanied by his wife. \r

\r “To make that initial step was hard. Nobody wants the stigma of going to see mental health, but it’s probably the best thing I’ve ever done,” he said. He still goes to therapy at the Worcester Veterans Center. \r

\r Two years ago, Mr. Moore, 51, started the “Route 9 Veterans Forum,” a monthly cable television show broadcast in 80 communities throughout the state. The show, which is also seen by American military personnel serving in Iraq and Afghanistan, features people from the veteran community who discuss services available to veterans and their families. Dr. Tapper from the VA hospital in Boston was last month’s guest. \r

\r Next month’s guest, Army Maj. David A. Hencke, chief of Deployment Cycle Support for the National Guard, will discuss the Yellow Ribbon Program mandated by the National Defense Act of 2008. \r

\r The goal of the program is to bolster outreach to veterans by coordinating local, state and federal services for veterans with those provided by non-government organizations. It primarily serves veterans of the National Guard and Reserves. The Massachusetts program, Operation Total Warrior, will operate from the Wellesley National Guard Armory. The facility, which officially opens in mid-December, was recently named The Service Member and Family Support Center. \r

\r “We call our program Operation Total Warrior because it’s the spiritual, emotional, mental and physical makeup (of veterans) that we’re addressing. To be a total warrior, you have to be fit and equipped in these four areas,” said Maj. Hencke, who is the executive officer of the 181st Infantry Regiment in Worcester. \r

\r A primary task calls for operations staff to coordinate pre-deployment, deployment and post-deployment seminars for service members and their families. \r

\r “If you do these seminars and workshops before they go, hopefully, you short-circuit a lot of issues,” Maj. Hencke said, comparing the efforts to preventive medicine. \r

\r Re-integration seminars for returning veterans are required under the new federal legislation. About 800 veterans and family members attended the first one held in September at the DCU Center in Worcester. Veterans are required to attend four of the nearly dozen workshops dealing with personal and family-related issues. During the post-deployment phase, veterans are also required to meet with counselors. \r

\r About 40 percent of service members returning from Iraq and Afghanistan, or more than 340,000, have accessed VA health care services, according to the U.S. Government Accountability Office. \r

\r But many veterans who know about services are not seeking them because of pride, peer pressure and other reasons, said Darrell P. Keating, director of Montachusett Veterans Outreach Center Inc. in Gardner. An outreach coordinator has met with every veteran services officer in each of the 22 Central Massachusetts cities and towns served by the Montachusett center. He has gone to civic clubs, churches and job fairs, but veterans are not coming for the services, Mr. Keating said. \r

\r “On this Veterans Day, they need to be in your thoughts. We’re just hoping that we can reach those who need help,” he said.

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